Insurance coverage of ketamine treatment
 

My doc told me insurance considers ketamine treatment experimental and is not covered. Is that true for all carriers or perhaps he was just
talking about my specific insurance.
Can people let me know how to proceed with ketamine and what the costs are?
thanks,
LogicWoman:confused:

No insurance doesn't cover ketamine treatments, he is right because it's considered experimental. Not enough numbers to show that it works consistently has come out from using it. I've never had it done, but another member here MSDrea had one awhile back and has 2 months pain free. I remember she mentioned needing to come up with another 2k for another infusion.

Hugs,

Karen

Not all Ketamine denied by insurance
 

It's not necessarily true that insurance companies deny payment for Ketamine infusions. We have Blue Cross/Blue Shield PPO and my wife had her 5-day in-patient low-dose infusion fully covered in Boston as well as outpatient infusions with a local physician here in Florida. In the first treatment in Boston her physician wrote a letter for the pre-approval for the inpatient treatment which outlined the studies, other failed treatments, and this treatment was generally as a last resort for pain relief. We didn't have to do this with the outpatient ones in Florida which were done by a BC/BS preferred provider. So, even though it has been generally considered experimental, the current clinical trials and documentation has helped get it recognized by insurance companies.

BigBug,
So after the her doctor sent a letter siting in outline the studies done, other failed treatments your wife had done & how this was generally used as a last resort for RSD pain relief they actually caved in & paid for it???? WOW I am truly amazed. Makes me sure wish I had insurance other than Medicare right now for sure. I don't think they would cave in for any reason. Not until it was paid for alot by other insurances. Unless...........What most insurance companies do is bargain to pay medical facilities, doctors & other types of medical professionals etc as close as they can to what Medicare pays for the same medical facilites, doctors & other professionals. So if one could site, like I said, all the above that you did plus what private insurance companies are allowing this procedure to be done they just might pay for it. Also, BigBug what type of doctor did the letter writing for your wife?? Was he a Pain Management or Neurologist or other type of doctor? That also would be worth knowing.

So is there anyone else out there that has had this procedure, 5 day inpatient Ketamine infusions, paid for by their insurance company. Doesn't matter if they have their insurance through their work or they pay for it on their own, it is considered to be private insurance. Anyway if your insruance has paid for this procedure we might all benefit from knowing this information. That way we can maybe get not only Medicare to pay for this but get other private insurance companies to ante up also. What do ya'll think???

It is worth a try right???

DebbyV

I have had 3 - 5 day low dose infusions each with boosters and my insurance paid for it, outside of deductable and copay's. I really could not tell you why some get paid for and some don't. Over the time that I had the treatments I had 2 different insurance companies also. Good Luck...

Gabbycakes

All the insurances are different.

BC/BS PPO is a pretty liberal carrier.

But some are quite stingey.... It is always a good idea to
try the prior authorization procedure outlined in your policy.

It has been my experience that HMO's are the most likely to
decline, even with a doctor's prior approval request.

Hi everyone,

I am new here and just following yor thread. I have experienced denials from my insurance also BC/BS HMO I have another name for them too! My husband is employed by local hospital where I have been treated. Nurses in general say that the insurances automatically spit out a denial without any consideration or even looking at it for that matter. The second response sent gets put in another slot. The nurses told me to pe persistant. I did an appeal for out of network surgery and won. It is dificult to do because I was heavily medicated and in a lot of pain at the time. I made points at the insurance of how they approved my SCS trial in network that cost 37000.00 and it was not guaranteed to work, but they would not approve a 12000.00 surgery that was likely to work or hekp considerably. I also faxed 3 hrs of medical records, 2 drs letters and photos of my RSD. The appeals specialist said i won because they had so much info. The appeals physician in midwest wrote a very short you better reverse your denial. Insurance co's are only willing to agree when they feel you might have something to bring against them. When they turn you down they are hoping that you will go away and sadly they win to much.

If anyone would like to see my letter or have a copy I would be more than happy to share.

I hope this was helpful. Knowone should have to go through this process.

fondly
debbie

Thanks for all the great information. Does any one know if ketamine has ever, or is in the process of, being tested in clinical trials?
thanks,
LogicWoman

A few years ago I spoke with the German physician who conducted the low dose trials along with the deep coma treatment. Based on his findings at that time he had decided to stop the low dose trials, he found that there was limited benefit to the patients and it required ongoing booster treatments. He advised me against it, instead he recommended lidocaine infusions before trying the deep coma option. I have a copy of his published findings some where in my files which I can send to you if you pm me with your email. I know further research has been done in the USA and elsewhere but I am not aware of any published findings. Lidocaine definitely has far less side effects than ketamine and is quite effective.

MsL

Question about BC/BS coverage for Ketamin infusions
 

Hi, I also live in Florida and I haven't found any doctor other than Dr. Kirkpatrick at the research center that even does this treatment..Could you please let me know the doctor that accepted BC/BS PPO, that is exactly what I have but because I am not able to go back to my job I may lose my insurance in 3 months. Thank you, Pepper PS...I live near Tampa

thought i'd pop in and let ya know about what i went through...

the doc i saw only took cash. regardless it is not covered by insurance. however! along with medicare and medical i am still on blue shield and my parents called them and they told us they would reimburse us for the costs. so we paid the $2k- $1 for the doc and the other for the facility, and we submitted the reciepts to blue cross and they have reimburst us.

with there being more infusions done and data being collected on how beneficial the infusions are for us in chronic pain, hopefully they will be covered by insurance. but i would highly reccommend inquiring with ur insurance company about seeing if they'll reimburst u. never hurts to ask!

That's creative billing on the part of the doc/center. Makes sense, though. Physician claims will be denied more quickly and easily that a related facility charge.

Dear Liz,

I'm so sorry to hear that your insurance company won't cover the IV lidocaine any longer. I do hope you get the appeal approved and you are grandfathered for the IV lidocaine but in case this doesn't happen have you talked to your doctor about having it done subcutaneously instead of by IV?

Here our pain clinic has switched most patients over to the subcutaneous treatment because it is less expensive but just as effective as the IV. This is administered under the out patient clinic and we are sent home with the pump which runs for about 8 hours. My doctor gives me a small bolus of the lidocaine on top of the pump so he keeps me for about 15 minutes to be on the safe side.

With the IV Lidocaine the protocol required that they had to book a bed in the PAR area with a dedicated nurse to monitor us on the heart monitor. With the subcutaneous pump the heart monitor is not required, so overall the treatment cost is reduced significantly. Lidocaine is cheap, and so is the baxter pump that is used. Here is a picture of it. This is saving our medical system huge $$$ and my doctor is able to treat more patients with pretty much the same results. Patients are getting help.

I know my pain doctor to be a kind man who would be available to taking a call from a colleague about the protocols they have established for subcutaneous lidocaine. PM me and I will forward his contact info for you along with the patient information sheet.

MsL

All this information has been very informative. I also am new, and have been told to have the ketamine infusions. I do have BC/BS PPO and had been told by the doctors office that it is covered for the 10 day treatment under my plan. I am not scheduled until September and don't know how I am going to survive on pain medication/neurontin. I am in constant pain and have a very active life with not a whole lot of help. I'm afraid that one day I'm just going to tell my husband that he's got to figure this out on his own and give up! I don't want to do that. I don't know how to get it through his head that this is real and hard! Sorry, Linda:confused:

I love lidocaine.!!! Did I say LOVE :winky:

What is striking to me and my doctors is the immediate relief I have from the the atrophy and the burning. The best part is not having to deal with zombie like symtoms of all the other drugs. Had my sub -cutaneous yesterday and I'm good to go for another 2 weeks.

Good luck getting it approved and let me know if you need any more information.

MsL

Lidocaine is great!
 

Hello it's ben awhile..

I have been getting subcutanious lidocaine infusions for almost a year now and they have given me back so much of my life.. I was mostly bed bound before, once my rsd went full body I could not tollerate a breeze or moving air on my body anywhere and all my clothes hurt me to wear. The infusions changed all that, I still can't wear a bra but I can wear the rest of my clothes with little iritation, and I was gardening again last summer (it was such a treat).

I get around 3 weeks of moderate relief from an infusion, I still get alot of flareups if I am not careful and for some reason sometimes they seem to work better than others.. my infusions tend to run through me too fast so I have to clamp the line off once in awhile, but that is manageable. WCB pays for my treatments.

Good luck and be well,
:grouphug:
Sandra

I'm very new to the RSD site. I had tried lidocane patches for TOS and also lidocane site injections with no relief. Is there a place I can go to research these infusions? I am supposed to have ketimine infusions and am trying to research all options. Any help would be greatly appreciated. Linda

Hi Linda,

If you pm me with your email address I can send you the information that I have on hand. The files I have are are too large to be posted on the forum. I've been told that my next step would be Ketamine should Lidocaine fail me. So far I've been OK and I've been having lidocaine for the past few years now.

MsL

I'm happy to meet someone else who is finding benefit from these infusions. It is great to be able to do such basic things like gardening isn't it! Even if we do have to pace ourselves the lidocaine helps me to manage day to day activities. Yes I do also have some fluctuation in pain levels especially since I was switched over to the subcutaneous pump last Jan. Actually I prefer the IV as it gives me instant relief, so much so that my doctor is giving me a bolus with each infusion to give me that little extra boost that I was used to with the IV infusion. We are considering a return to that but I wanted to give the subcutaneous a good effort. I think the government is putting the screw to the doctors here to reduce costs. All in all with both methods I find it is like a battery wearing down and by the end of the 2nd week I'm looking forward to my next infusion.

Back to the original question which I believe is regarding Ketamine and insurance coverage. Were you ever offered ketamine treatments in Canada?

Warm wishes

MsL

Florida ketamine infusions
 

I also live in Tampa. My doctor does this treatment. I'm in the process of getting it scheduled. The best place is Florida Spine Institute and see Dr Hannah. He us the best and if your insurance doesn't cover it all they will sit u up with a payment plan.Their phone number is (727)7977463 They ate located on Drew Street in Clearwater. Takes about 25 minutes to get there. Good luck and I hope this helps

i have never tried ketamine so i don't know about insurance coverages on it but hope that if you do get covered for it and try it that it helps you to feel better. soft hugs.

Yes there are research studies current and past w/ ketamine. Dr. Robert Schwartzman was an early researcher. He can be googled or looked up on you tube. There is at least one govt. study but not sure if results are published. Again google ketamine for CRPS and you will find lots of info and doctors using it. Aetna ins. does not pay for the treatment and the cost is very difficult to pay out of pocket, especially with all the boosters usually required to maintain results. There is enough evidence that it is effective for many with this illness. It needs to be offered more freely and cost effectively to those that want to try it. Too few effective treatment are offered us.:mad:

http://www.cspmr.net/files/AnnualMee...14_handout.pdf

This handout lists treatments with information regarding efficacy.